1
|
Jang GY, Chang SJ, Noh JH. Relationships Among Health Literacy, Self-Efficacy, Self-Management, and HbA1c Levels in Older Adults with Diabetes in South Korea: A Cross-Sectional Study. J Multidiscip Healthc 2024; 17:409-418. [PMID: 38314013 PMCID: PMC10838094 DOI: 10.2147/jmdh.s448056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose This study investigated the levels of health literacy, self-efficacy, self-management, and glycated hemoglobin (HbA1c) levels in older adults with diabetes to identify the relationships between these factors. Patients and Methods This descriptive study consisted of 162 elderly outpatients with diabetes at the departments of endocrinology of three general hospitals in J Province, South Korea. Data were collected using a structured self-report questionnaire between October 21 and November 16, 2019. The data were analyzed using SPSS/WIN version 23.0. Results Health literacy was positively correlated with self-efficacy (rs=0.64, p<0.001) and self-management (rs=0.44, p<0.001) and significantly negatively correlated with HbA1c levels (rs=-.42, p<0.001). Self-efficacy showed a significantly positive correlation with self-management (rs=0.65, p<0.001) and a significantly negative correlation with HbA1c levels (rs=-.30, p<0.001). Moreover, a significant negative correlation was found between self-management and HbA1c levels (rs=-.35, p<0.001). Hence, health literacy and patient self-management levels were associated with HbA1c levels in older adults with DM. Conclusion Health education for community-dwelling older adults with diabetes should consider their health literacy levels. Moreover, measures to improve self-management abilities may be needed when developing educational programs for older adults with diabetes.
Collapse
Affiliation(s)
- Geun Young Jang
- College of Nursing, Graduate School of Woosuk University, Wanju-gun, Jeonbuk, South Korea
| | - Soo Jung Chang
- Department of Nursing Gangneung-Wonju National University, Wonju, Gangwon-do, South Korea
| | - Jun Hee Noh
- College of Nursing, Woosuk University, Wanju-gun, Jeonbuk, South Korea
| |
Collapse
|
2
|
Egbuonu I, Trief PM, Roe C, Weinstock RS. Glycemic outcomes related to depression in adults with type 1 diabetes. J Health Psychol 2021; 26:786-794. [PMID: 33904320 DOI: 10.1177/1359105319845134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Glycemic outcomes of adults with type 1 diabetes may be affected by depression. Our aim was to compare outcomes of "depressed" (Patient Health Questionnaire-9 ⩾ 10, N = 83) to "not-depressed" matched control (Patient Health Questionnaire-2 < 3, N = 166) adults with type 1 diabetes with objective measures. The depressed group had poorer blood glucose control and, for those with glucose meter downloads, fewer glucose tests/day. The groups did not differ on glucose variability or episodes of hypoglycemia. Depression in adults with type 1 diabetes is associated with poorer glycemic control and less blood glucose monitoring. Future research should examine whether treatment of depression results in better self-care and glycemic outcomes.
Collapse
Affiliation(s)
- Ifeoma Egbuonu
- State University of New York Upstate Medical University, USA
| | - Paula M Trief
- State University of New York Upstate Medical University, USA
| | - Cheryl Roe
- State University of New York Upstate Medical University, USA
| | | |
Collapse
|
3
|
Schmitt A, McSharry J, Speight J, Holmes-Truscott E, Hendrieckx C, Skinner T, Pouwer F, Byrne M. Symptoms of depression and anxiety in adults with type 1 diabetes: Associations with self-care behaviour, glycaemia and incident complications over four years - Results from diabetes MILES-Australia. J Affect Disord 2021; 282:803-811. [PMID: 33601721 DOI: 10.1016/j.jad.2020.12.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/28/2020] [Accepted: 12/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether symptoms of depression or anxiety predict glycaemia and incident diabetes complications four years later, and whether diabetes self-care behaviours mediate these associations, in adults with type 1 diabetes (T1DM). METHODS Data of 205 adults with T1DM from the 2011 and 2015 Diabetes MILES-Australia surveys were analysed. Variables of interest were: baseline depression and anxiety (PHQ-8 and GAD-7, respectively) symptoms; HbA1c and incident complications at four-year follow-up; and self-care behaviours at both time points. Longitudinal associations were analysed using structural equation modelling. RESULTS Forty-two participants (20.6%) reported incident complications. Baseline depressive symptoms predicted higher HbA1c at follow-up indirectly via less optimal self-care at follow-up (β = 0.19, P = 0.011). Baseline anxiety was not independently associated with HbA1c or self-care at follow-up (P ≥ 0.64). Neither depressive nor anxiety symptoms predicted incident complications, although depressive symptoms were associated with less optimal self-care at baseline (β = -0.67, P < 0.001), and this predicted microvascular complications (β = -0.38, P = 0.044); however, the indirect association via self-care was not significant (β = 0.25, P = 0.067). LIMITATIONS Participants were self-selected; all study variables were assessed using self-report measures; and adjusting for baseline HbA1c was not possible. CONCLUSIONS Depressive symptoms predicted suboptimal self-care behaviour and glycaemic outcome four years later, while anxiety symptoms did not. The findings suggest that tailored diabetes care should take the potential impact of comorbid depression into consideration to help people improve their diabetes self-care and achieve best possible health outcomes.
Collapse
Affiliation(s)
- Andreas Schmitt
- Diabetes Center Mergentheim, Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), Ingolstaedter Landstraße 1, 85764 Muenchen-Neuherberg, Germany.
| | - Jennifer McSharry
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Melbourne, Victoria, Australia
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark
| | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
4
|
Zuñiga JA, Harrison ML, Henneghan A, García AA, Kesler S. Biomarkers panels can predict fatigue, depression and pain in persons living with HIV: A pilot study. Appl Nurs Res 2019; 52:151224. [PMID: 31987713 DOI: 10.1016/j.apnr.2019.151224] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/13/2019] [Accepted: 12/21/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Persons living with HIV experience high symptom burden that can negatively impact medication adherence, work productivity, and quality of life. Symptoms are highly subjective, which can lead to under- or improper treatment. The purpose of this exploratory study was to examine relationships between circulating biomarkers representative of inflammatory, coagulation, and vascular function pathways and prevalent HIV symptoms. SETTING AND SAMPLE Adults >18 years who were diagnosed with HIV and spoke English for this cross-sectional study were recruited from community clinics and organizations. METHODS Symptom burden was measured with the HIV Symptom Index; depression with the Patient Health Questionnaire. Human multiplex kits were used to determine serum concentrations of select biomarkers representing inflammatory, coagulation, and vascular function pathways. The biomarkers were included as features in machine learning models to determine which biomarkers predicted the most prevalent HIV symptoms (fatigue and muscle/joint pain) and the symptom of depression. RESULTS Participants (N = 32) were representative of the local population of people with HIV, being mostly Black (54.4%) and male (60.6%). Depression was predicted by age, gender, glucose, hemoglobin A1c, and inflammation. Muscle/joint pain was predicted by adiponectin, C-reactive protein, and serum amyloid A (SAA). Fatigue was predicted by adiponectin, SAA, and soluble interleukin-1 receptor type II (sIL-1RII). CONCLUSION Biomarker clusters can be a tool to monitor symptoms. Adding an objective measure to subjective patient experiences could improve management and monitoring of symptoms. Defining a biomarker cluster for the objective assessment of HIV symptoms warrants further investigation; however, the presence of comorbid conditions needs to be controlled.
Collapse
Affiliation(s)
- Julie A Zuñiga
- The University of Texas at Austin, School of Nursing, United States of America.
| | - Michelle L Harrison
- The University of Texas at Austin, College of Education, Department of Kinesiology and Health Education, United States of America
| | - Ashley Henneghan
- The University of Texas at Austin, School of Nursing, United States of America
| | - Alexandra A García
- The University of Texas at Austin, School of Nursing, United States of America
| | - Shelli Kesler
- MD Anderson, Department of Neuro-Oncology, Division of Cancer Medicine, United States of America
| |
Collapse
|
5
|
Egbuonu I, Trief PM, Roe C, Weinstock RS. Glycemic outcomes related to depression in adults with type 1 diabetes. J Health Psychol 2019; 26:1282-1290. [DOI: 10.1177/1359105319877298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Glycemic outcomes of adults with type 1 diabetes may be affected by depression. Our aim was to compare outcomes of “depressed” (Patient Health Questionnaire-9 ⩾ 10, N = 83) to “not-depressed” matched control (Patient Health Questionnaire-2 < 3, N = 166) adults with type 1 diabetes with objective measures. The depressed group had poorer blood glucose control and, for those with glucose meter downloads, fewer glucose tests/day. The groups did not differ on glucose variability or episodes of hypoglycemia. Depression in adults with type 1 diabetes is associated with poorer glycemic control and less blood glucose monitoring. Future research should examine whether treatment of depression results in better self-care and glycemic outcomes.
Collapse
Affiliation(s)
- Ifeoma Egbuonu
- State University of New York Upstate Medical University, USA
| | - Paula M Trief
- State University of New York Upstate Medical University, USA
| | - Cheryl Roe
- State University of New York Upstate Medical University, USA
| | | |
Collapse
|
6
|
Relationship of depression to diabetes, prediabetes and nondiabetics according to HbA1c classification: Retrospective study on 72,175 patients. JOURNAL OF SURGERY AND MEDICINE 2017. [DOI: 10.28982/josam.370527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
7
|
Pastor A, Conn J, Teng J, O'Brien CL, Loh M, Collins L, MacIsaac R, Bonomo Y. Alcohol and recreational drug use in young adults with type 1 diabetes. Diabetes Res Clin Pract 2017. [PMID: 28646702 DOI: 10.1016/j.diabres.2017.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol and other recreational drug use reaches peak prevalence in young adulthood, including for those with chronic medical conditions such as type 1 diabetes. This review summarises the current literature on the patterns of substance use amongst young adults with type 1 diabetes and the mechanisms through which alcohol and recreational drugs may affect diabetes related health outcomes. These include the direct physical effect of intoxication, as well as the effects of alcohol and drugs on mental health and glucose metabolism. Evidence for increased associated mortality and morbidity is also presented, and current guidelines, management strategies and directions for further research are discussed.
Collapse
Affiliation(s)
- Adam Pastor
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Jennifer Conn
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia
| | - Jessie Teng
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia
| | - Casey L O'Brien
- Mental Health Services, St Vincent's Hospital Melbourne, Australia; Department of Psychiatry, University of Melbourne, Australia
| | - Margaret Loh
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia
| | - Lisa Collins
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia
| | - Richard MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
| |
Collapse
|
8
|
Yang F, Pang JS, Cheng WJY. Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy. J Clin Psychol Med Settings 2016; 23:389-401. [PMID: 27738847 DOI: 10.1007/s10880-016-9470-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.
Collapse
Affiliation(s)
- Fang Yang
- Department of Social Work, School of Sociology and Political Science, Shanghai University, A501, 99 Shangda Road, Baoshan District, Shanghai, 200444, China.
| | - Joyce S Pang
- Division of Psychology, School of Humanities and Social Sciences, Nanyang Technological University, 14 Nanyang Drive, Singapore, 637332, Singapore
| | - Wendy J Y Cheng
- Psychological Services, INSEAD Asian Campus, 1 Ayer Rajah Avenue, Singapore, 138676, Singapore
| |
Collapse
|
9
|
Self-Efficacy, Depression, and Self-Care Activities in Adult Jordanians with Type 2 Diabetes: The Role of Illness Perception. Issues Ment Health Nurs 2016; 37:744-755. [PMID: 27484761 DOI: 10.1080/01612840.2016.1208692] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diabetes mellitus is reaching epidemic levels worldwide. In a developing country like Jordan, type 2 diabetes mellitus (T2DM) has reached a prevalence rate of 17.1%. This cross-sectional study examined the relationship between self-care activities and: illness perception, depression, social support, religiosity and spiritual coping, and self-efficacy among patients with T2DM. A random sample of 220 patients with T2DM, who attended Jordan University Hospital in Jordan were enrolled. The data were collected through a structured interview and the medical files. The instruments consisted of a sociodemographic and clinical standardised questionnaires: Brief Illness Perception Questionnaire, Patients' Health Questionnaire-9; ENRICH Social Support Instrument; Religious and Spiritual Coping Subscale; Diabetes Management Self-Efficacy Scale; and Summary of Diabetes Self-Care Activities. Bivariate analysis investigated the relationship between variables. Structure Equation Modelling (SEM) was performed to test the proposed conceptual model. The study found that approximately 70% of the respondents suffered some form of depressive symptoms. The SEM showed a direct relationship between self-efficacy and self-care activities (β = 0.40; p < 0.001). Depression was indirectly related to self-care activities through self-efficacy (β = -0.20; p = 0.003); nevertheless, it was directly related to perception of: treatment control, consequences, and emotional representations. Overall, the sequence between illness perception and self-efficacy was mediated by depression. Strategies to promote self-efficacy and illness perception are vital in customising a diabetes health plan to meet Arabic cultural expectations.
Collapse
|
10
|
Bächle C, Lange K, Stahl-Pehe A, Castillo K, Scheuing N, Holl RW, Giani G, Rosenbauer J. Symptoms of Eating Disorders and Depression in Emerging Adults with Early-Onset, Long-Duration Type 1 Diabetes and Their Association with Metabolic Control. PLoS One 2015; 10:e0131027. [PMID: 26121155 PMCID: PMC4487688 DOI: 10.1371/journal.pone.0131027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023] Open
Abstract
Background This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control. Methods In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c. Results A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, p<0.001). However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006). Conclusions Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes.
Collapse
Affiliation(s)
- Christina Bächle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- * E-mail:
| | - Karin Lange
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
| | - Anna Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Katty Castillo
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Nicole Scheuing
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| | - Reinhard W. Holl
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
| | - Guido Giani
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| |
Collapse
|
11
|
Cassimatis M, Kavanagh DJ, Hills AP, Smith AC, Scuffham PA, Edge S, Gibson J, Gericke C. Development of the OnTrack Diabetes Program. JMIR Res Protoc 2015; 4:e24. [PMID: 26013840 PMCID: PMC4461785 DOI: 10.2196/resprot.2823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 04/01/2014] [Accepted: 07/28/2014] [Indexed: 01/15/2023] Open
Abstract
Background Type 2 diabetes affects an estimated 347 million people worldwide and often leads to serious complications including blindness, kidney disease, and limb amputation. Comorbid dysphoria is common and is an independent risk factor for poor glycaemic control. Professional support for diabetes self-management and dysphoria has limited availability and involves high costs, especially after regular hours, and in rural and remote areas. Web-based cognitive behavior therapy offers highly accessible, acceptable, and cost-effective support for people with diabetes. This paper describes the development of OnTrack Diabetes, a self-guided, Web-based program to promote improved physical and emotional self-management in people with Type 2 diabetes. Objective The objective of the study is to describe the development of the OnTrack Diabetes program, which is a self-guided, Web-based program aimed to promote euthymia and improved disease self-management in people with Type 2 diabetes. Methods Semistructured interviews with 12 general practitioners and 13 patients with Type 2 diabetes identified enablers of and barriers to effective diabetes self-management, requirements for additional support, and potential program elements. Existing resources and research data informed the development of content, and consultants from relevant disciplines provided feedback on draft segments and reviewed the program before release. Using a self-guided delivery format contained costs, in addition to adapting program features and modules from an existing OnTrack program. Results A separate paper describes the protocol for a randomized controlled trial to provide this required evaluation. Conclusions Development of the OnTrack Diabetes program demonstrates strategies that help ensure that a program is acceptable to users. The next stages involve testing users’ experiences and examining the program’s effectiveness and cost-effectiveness in randomized controlled trials. Trial Registration The Australian New Zealand Clinical Trials Registry (ACTRN): 12614001126606;
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001126606 (Archived by WebCite at
http://www.webcitation.org/6U0Fh3vOj).
Collapse
Affiliation(s)
- Mandy Cassimatis
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Bächle C, Lange K, Stahl-Pehe A, Castillo K, Holl RW, Giani G, Rosenbauer J. Associations between HbA1c and depressive symptoms in young adults with early-onset type 1 diabetes. Psychoneuroendocrinology 2015; 55:48-58. [PMID: 25720348 DOI: 10.1016/j.psyneuen.2015.01.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/15/2015] [Accepted: 01/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to evaluate the associations between metabolic control and each DSM-5 (Diagnostic and Statistical Manual, fifth edition) symptom of depression among young women and men with early-onset long-duration type 1 diabetes. METHODS The data of 202 18-21-year-old patients with type 1 diabetes from a population-based, nationwide survey (40.1% male) with a mean age of 19.4 (standard deviation 0.9) years, a mean HbA1c level of 8.3% (1.6%) (i.e., 67 [17.5]mmol/mol), and a mean diabetes duration of 15.7 (1.0) years were included. The German version of the Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. For each PHQ-9 depressive symptom, the mean HbA1c values of screening-positive and screening-negative patients were compared via t-test. The associations between HbA1c levels and depressive symptoms were analyzed using multiple linear regression analyses and stepwise adjustments for individual, socioeconomic and health-related covariates. RESULTS Exactly 43.0% and 33.3% of female and male participants reported at least one depressive symptom, and 5.0% and 2.5% met the DSM-5 criteria for major depressive syndrome. HbA1c levels increased with psychomotor agitation/retardation (women), overeating/poor appetite (men/women), lethargy (men), and sleep difficulty (men). Overeating/poor appetite, lethargy, and total PHQ-9 score (per score increase by one) were associated with increased HbA1c levels of 1.10, 0.96 and 0.09 units (%), respectively. CONCLUSIONS The associations between depressive symptoms and HbA1c levels vary by symptom and sex. Differentiating the symptoms of depression and targeted interventions might help to improve metabolic outcomes in young adults with early-onset type 1 diabetes and depression.
Collapse
Affiliation(s)
- Christina Bächle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany.
| | - Karin Lange
- Hannover Medical School, Department of Medical Psychology, Carl-Neuberg-Str. 1, OE 5430, D-30626 Hannover, Germany
| | - Anna Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany
| | - Katty Castillo
- German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany
| | - Reinhard W Holl
- German Center for Diabetes Research (DZD), Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, Albert-Einstein-Allee 41, D-89081 Ulm, Germany
| | - Guido Giani
- German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany
| | - Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Germany
| |
Collapse
|
13
|
Al-Amer R, Ramjan L, Glew P, Salamonson Y. Diagnosis of Type 2 Diabetes: The Experience of Jordanian Patients with Co-existing Depression. Issues Ment Health Nurs 2015; 36:231-8. [PMID: 25897571 DOI: 10.3109/01612840.2014.960627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In Jordan, Type 2 diabetes mellitus (T2DM) is becoming a significant health problem, and a high concomitant rate of depression among this population complicates the situation. This qualitative study explored and described the emotional reactions of Jordanian patients with co-existing depression, on diagnosis of T2DM. Data were collected using semi-structured qualitative interviews from 15 patients with T2DM and depression in 2013. Interviews were audiotaped, translated and then analysed using thematic analysis. A major theme-'Initial reactions to the diagnosis'-emerged with four accompanying sub-themes (Devastation, Mixed Emotions, Denial and Acceptance). Although the majority of participants expressed negative emotional reactions on first diagnosis, a strong religious conviction allowed for acceptance of the diagnosis. Overall, the study findings support that in Arabic countries, spirituality and faith played a key role in promoting acceptance of concomitant comorbidities, and will often be useful in enhancing positive coping strategies among patients with T2DM and depression.
Collapse
Affiliation(s)
- Rasmieh Al-Amer
- School of Nursing and Midwifery, University of Western Sydney , Penrith, NSW , Australia
| | | | | | | |
Collapse
|
14
|
Pain and functional impairment as mediators of the link between medical symptoms and depression in type 2 diabetes. Int J Behav Med 2014; 20:22-9. [PMID: 22198562 DOI: 10.1007/s12529-011-9210-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Among people with diabetes, depression is more common and is associated with greater morbidity and mortality. A better understanding of mechanisms underlying the link between poor health and depression is needed. Pain and functional impairment may account for the effect of poor health on depression in diabetes. PURPOSE The purpose of the study was to examine whether pain and functional impairment mediate the association between diabetes-related medical symptoms and depression in type 2 diabetes. METHOD Adults diagnosed with type 2 diabetes (N = 77) completed the following measures: Patient Health Questionnaire (PHQ), Diabetes Symptom Checklist (DSC), and Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Body mass index (BMI) was computed using height and weight data from medical records. Mediation and linear regression analyses were conducted. RESULTS Pain and functional impairment made significant, independent contributions to depression. Functional impairment mediated the link between diabetes-related medical symptoms and depression. Pain mediated the association between higher BMI and depression. CONCLUSION Pain and functional impairment appear to play important, independent roles in depression in type 2 diabetes. Mediation analyses suggest the following: 1. diabetes-related medical problems increase functional impairment, which in turn leads to greater depression; and 2. the burden of carrying greater body mass (higher BMI) increases pain, which leads to increased depression.
Collapse
|
15
|
Carvajal DN, Ghazarian SR, Shea Crowne S, Bohrer Brown P, Carter Pokras O, Duggan AK, Barnet B. Is depression associated with contraceptive motivations, intentions, and use among a sample of low-income Latinas? Womens Health Issues 2014; 24:e105-13. [PMID: 24439935 DOI: 10.1016/j.whi.2013.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/25/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Latinas in the United States experience high rates of unintended pregnancy and low rates of contraception use, yet reasons are not completely understood. Depression is common among pregnant and nonpregnant Latinas; its influence on contraceptive motivations, intentions, and use is understudied. OBJECTIVES We sought to 1) describe Latinas' contraceptive motivations, intentions, and use; 2) use structural equation modeling to test associations between depression and contraceptive self-efficacy/motivations/intentions/use; and 3) determine whether associations differ by pregnancy status. METHODS This cross-sectional study included Latinas ages 15 to 45 recruited from an urban Federally Qualified Health Center in Baltimore, Maryland. Structured surveys were used to collect data regarding depressive symptoms measured using the PHQ-9. All other constructs were measured with previously validated questions. Constructs included contraceptive self-efficacy, positive and negative contraceptive motivations (perceived advantages and disadvantages of using contraception), contraceptive intentions to begin or continue contraception use, and contraceptive methods currently used. RESULTS Among pregnant Latinas, depression was associated with negative motivations (β = 0.16; p < .05), negative motivations were associated with intentions (β = -0.22; p < .01), and contraceptive self-efficacy was associated with intentions (β = 0.43; p < .001). Among nonpregnant Latinas, contraceptive self-efficacy was associated with intentions (β = 0.78; p < .001) and intentions were associated with use (β = 0.40; p < .05). CONCLUSIONS Among pregnant Latinas, negative motivations intervene in the association between depression and contraceptive intentions. For nonpregnant Latinas, intentions intervene in the association between self-efficacy and contraceptive use. This study underscores the importance of depression screening during pregnancy and encourages practitioners to target contraceptive motivations to improve contraceptive use.
Collapse
Affiliation(s)
- Diana N Carvajal
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Sharon R Ghazarian
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Center for Child & Community Health Research, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Shea Crowne
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Bohrer Brown
- Maternal and Child Health and Multicultural Programs, Baltimore Medical System, Inc., Baltimore, Maryland
| | - Olivia Carter Pokras
- Department of Epidemiology and Biostatistics, University of Maryland College Park School of Public Health, College Park, Maryland
| | - Anne K Duggan
- Department of Pediatrics, Health Policy and Management, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Beth Barnet
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
16
|
Azimova K, Rude J, Mallawaarachchi I, Dwivedi A, Sarosiek J, Mukherjee D. Glucose Levels and Depression in Hispanic Patients Admitted to the Cardiovascular Intensive Care Unit. Angiology 2013; 66:57-64. [DOI: 10.1177/0003319713513318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Depression is frequently associated with diabetes mellitus (DM) and may worsen DM-related morbidity and mortality. We determined the potential association of glucose levels with depression in Hispanic patients admitted to the Cardiovascular Intensive Care Unit. Patients were given the Center for Epidemiologic Studies—Depression scale survey within 24 hours of admission. Glycated hemoglobin and fasting blood glucose levels within 30 days of admission were extracted. The HbA1c levels remained significantly associated with both presence of depression and depression levels. Histories of DM, myocardial infarction, and percutaneous coronary intervention as well as baseline brain natriuretic peptide levels were also significantly associated with depression levels. The presence of a significant association between glucose levels and depression in Hispanic patients indicates that there is a need for optimal management of glycemic levels. This may then lead to better health outcomes in Hispanics with cardiovascular disease.
Collapse
Affiliation(s)
- Komola Azimova
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jennifer Rude
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Indika Mallawaarachchi
- Division of Biostatistics & Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alok Dwivedi
- Division of Biostatistics & Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Jerzy Sarosiek
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Debabrata Mukherjee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| |
Collapse
|
17
|
Celano CM, Beale EE, Moore SV, Wexler DJ, Huffman JC. Positive psychological characteristics in diabetes: a review. Curr Diab Rep 2013; 13:917-29. [PMID: 24048687 DOI: 10.1007/s11892-013-0430-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.
Collapse
|
18
|
Abstract
Comorbidity of depression and diabetes is common, and each disorder has a negative impact on the outcome of the other. The direction of causality is not certain as each disorder seems to act as both a risk factor and consequence for the other in longitudinal studies. This bidirectional association is possibly mediated by shared environmental and genetic risk factors. Comorbid depression is associated with reduced adherence to medication and self-care management, poor glycaemic control, increased health care utilization, increased costs and elevated risk of complications, as well as mortality in patients with diabetes. Psychological and pharmacological interventions are shown to be effective in improving depression symptoms; however, collaborative care programs that simultaneously manage both disorders seem to be most effective in improving diabetes-related outcomes.
Collapse
Affiliation(s)
- Bibilola D Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | | |
Collapse
|
19
|
Robertson SM, Amspoker AB, Cully JA, Ross EL, Naik AD. Affective symptoms and change in diabetes self-efficacy and glycaemic control. Diabet Med 2013; 30:e189-96. [PMID: 23350920 PMCID: PMC3628998 DOI: 10.1111/dme.12146] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 12/14/2022]
Abstract
AIMS To examine the role of baseline depression, anxiety and stress symptoms on post-intervention diabetes self-efficacy and glycaemic control (HbA(1c)). METHODS The current study analysed data from patients (n = 85) with treated but uncontrolled Type 2 diabetes who participated in a comparative effectiveness study of two diabetes self-management interventions. Hierarchical linear regression was used to examine the relationships between baseline affective symptoms and post-intervention diabetes self-efficacy and the moderating effects of baseline affective symptoms on the relationship between changes in diabetes self-efficacy and post-intervention HbA(1c). RESULTS Baseline depression was inversely associated with post-intervention diabetes self-efficacy (P = 0.0001) after adjusting for baseline characteristics including diabetes self-efficacy. In contrast, normal-mild levels of stress were associated with higher post-intervention diabetes self-efficacy (P = 0.04). Anxiety and stress symptoms significantly and independently moderated the relationship between changes in diabetes self-efficacy and post-intervention HbA(1c) (P = 0.02 and P = 0.03, respectively). Further evaluation of these interactions demonstrated that changes in diabetes self-efficacy were associated with lower post-intervention HbA(1c), but only among those with higher baseline affective symptoms. CONCLUSIONS We found a moderating effect across affective symptoms on the relationship between diabetes self-efficacy changes and post-intervention HbA1c in the context of a self-management intervention. Results suggest that patients with poorly controlled diabetes who have higher levels of depression, anxiety and stress symptoms may derive greater benefits from self-management interventions known to improve diabetes self-efficacy.
Collapse
Affiliation(s)
- S M Robertson
- Houston Health Services Research and Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, University of Houston, Houston, TX, USA.
| | | | | | | | | |
Collapse
|
20
|
Bernstein CM, Stockwell MS, Gallagher MP, Rosenthal SL, Soren K. Mental health issues in adolescents and young adults with type 1 diabetes: prevalence and impact on glycemic control. Clin Pediatr (Phila) 2013; 52:10-5. [PMID: 22988007 DOI: 10.1177/0009922812459950] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mental health comorbidities can negatively affect disease management in adolescents with chronic illnesses. This study sought to determine the prevalence and impact of mental health issues in a population of adolescents and young adults with type 1 diabetes. A cross-sectional study of 150 patients aged 11 to 25 years with type 1 diabetes from an urban, academic diabetes center was conducted. Participants completed 3 validated mental health disorder screening instruments: Beck's Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders-41 anxiety screen, and the Eating Disorder Screen for Primary Care. More than a third screened positive: 11.3% for depression, 21.3% for anxiety, and 20.7% for disordered eating (14.7% had ≥2 positive screens). Patients with a positive screen had twice the odds of having poor glycemic control as those without, as measured by HgbA1c. This study supports screening for mental health issues in adolescents and young adults with type 1 diabetes.
Collapse
Affiliation(s)
- Carrie M Bernstein
- Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | | | | | | | | |
Collapse
|
21
|
|
22
|
Kimbro LB, Steers WN, Mangione CM, Duru OK, Ettner SL. The Association of Depression and the Cardiovascular Risk Factors of Blood Pressure, HbA1c, and Body Mass Index among Patients with Diabetes: Results from the Translating Research into Action for Diabetes Study. Int J Endocrinol 2012; 2012:747460. [PMID: 23227045 PMCID: PMC3512290 DOI: 10.1155/2012/747460] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 10/09/2012] [Accepted: 10/17/2012] [Indexed: 11/19/2022] Open
Abstract
Diabetic patients are nearly three times as likely to have depression as their nondiabetic counterparts. Patients with diabetes are already at risk for poor cardiovascular health. Using cross-sectional data from the translating research into action for diabetes (TRIAD) study, the authors tested the association of depression with cardiovascular risk factors in diabetic patients. Depression was measured using the patient health questionnaire (PHQ8). Patients who scored greater than 9 on the PHQ8 were classified as depressed and were compared with those who were not depressed (n = 2,341). Depressed patients did not have significantly different blood pressure levels than those who were not depressed. However, those who were depressed had higher HbA1c levels than those who were not depressed (P < 0.01) and higher BMIs than those who were not depressed (P < 0.01). These results indicate that depressed diabetic patients are at greater risk of having poor control of cardiovascular risk factors and suggest that depression screening should be a standard practice among this patient group.
Collapse
Affiliation(s)
- Lindsay B. Kimbro
- Department of Medicine, David Geffen School of Medicine, University of California, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90025, USA
| | - W. Neil Steers
- Department of Medicine, David Geffen School of Medicine, University of California, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90025, USA
| | - Carol M. Mangione
- Department of Medicine, David Geffen School of Medicine, University of California, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90025, USA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, UCLA, Los Angeles, CA 90095, USA
- *Carol M. Mangione:
| | - O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90025, USA
| | - Susan L. Ettner
- Department of Medicine, David Geffen School of Medicine, University of California, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA 90025, USA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, UCLA, Los Angeles, CA 90095, USA
| |
Collapse
|
23
|
Hillege S, Beale B, McMaster R. Enhancing management of depression and type 1 diabetes in adolescents and young adults. Arch Psychiatr Nurs 2011; 25:e57-67. [PMID: 22114807 DOI: 10.1016/j.apnu.2011.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/15/2011] [Accepted: 08/08/2011] [Indexed: 11/28/2022]
Abstract
Anxiety, depression, and eating disorders are higher in adolescents and young adults with diabetes than in their unaffected counterparts worldwide. This descriptive qualitative research paper, using secondary analysis, described the experiences of adolescents and young adults living with depression and Type 1 diabetes. The study showed that depression negatively affected the participants physically, emotionally, and socially and impacted on their relationships. Negative dimensions of self had a flow-on effect for health management. A deeper understanding of these experiences may assist health professionals to enhance the management of affected adolescents and young adults, leading to better health outcomes.
Collapse
Affiliation(s)
- Sharon Hillege
- School of Nursing & Midwifery, College of Health and Science, the University of Western Sydney, NSW, Australia.
| | | | | |
Collapse
|